| NPI | 1255688495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REVA K B O'HALLARN Sole Member 757-873-1958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003845) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |